SUPPORT: An Evidence-Based Model for Leaders Addressing Moral Distress

J Nurs Adm. 2016 Jun;46(6):313-20. doi: 10.1097/NNA.0000000000000351.

Abstract

Objective: The aim of this study is to explore nurse leaders' experiences working in ethically difficult situations and helping nurses cope with moral distress.

Background: Moral distress is associated with ethically complex situations where nurses feel voiceless and powerless. Moral distress can lead to disengagement, burnout, and decreased quality of care.

Methods: The critical incident technique was used to collect descriptions of ethically complex situations from 100 nurse leaders in California. Responses were qualitatively coded, categorized, and subsequently counted.

Results: Participants noted affective, behavioral, cognitive, physical, and relational signs of moral distress. System-level factors along with team conflict and different perspectives were perceived to increase the probability of ethical conflicts. Key actions to address moral distress included acknowledging its presence, creating a culture of care, and increasing nurses' resilience to difficult circumstances through education, support, and collaboration.

Conclusions: On the basis of study findings, we created the SUPPORT model as an action guide for addressing moral distress.

MeSH terms

  • Adult
  • Aged
  • Conflict, Psychological*
  • Ethics, Nursing
  • Evidence-Based Nursing*
  • Female
  • Humans
  • Los Angeles
  • Male
  • Middle Aged
  • Models, Nursing*
  • Nurse Administrators / psychology*
  • Practice Patterns, Nurses' / ethics*
  • Surveys and Questionnaires